Under physiological circumstances, the cervix possesses a crucial role in maintaining the fetus within the uterine cavity throughout the entire pregnancy, but in the setting of cervical incompetence, defined as a painless dilation and shortening of the cervix during the second trimester, the cervix is unable to perform its respective function [1] [2]. As a result, the expulsion of a live fetus during the second (or sometimes third) semester is the main clinical presentation of cervical incompetence, frequently resulting in miscarriage or sometimes in premature birth [3] [4] [5] [6]. The pathogenesis is yet to be revealed, but several risk factors have been established. Firstly, a significant ethnic predisposition toward African-American women is observed when compared to Caucasian women [6]. Secondly, several conditions are associated with an increased risk for cervical incompetence, including polycystic ovarian syndrome (PCOS), use of diethylstilbestrol (DES), previous surgery (termination of pregnancy, repeated cervical dilation, cone biopsy, and several other procedures) or trauma (during vaginal or cesarean delivery), as well as Ehlers-Danlos syndrome and uterine abnormalities [1] [3] [4] [7]. Cervical incompetence is completely asymptomatic in the majority of cases prior to sudden fetal expulsion, while vaginal spotting or bleeding, abdominal or lower back pain, and discharge are seen in some women prior to the event [4].

• Cough

  The status of the cervix improved with standing in three cases, whereas this was not seen with transfundal pressure or coughing. There was no case where there was a positive response to standing or coughing and not to transfundal pressure. [ncbi.nlm.nih.gov]

  You have chills, a cough, or feel weak and achy. You have lower abdominal or back pain. You have questions or concerns about your condition or care. Care Agreement You have the right to help plan your care. [drugs.com]

  A comparison of ultrasonographically detected cervical changes in response to transfundal pressure, coughing, and standing in predicting cervical incompetence. Am J Obstet Gynecol. 1997;177(3):660-5. 75 Wong G, Levine D, Ludmir J. [glowm.com]

• Ulcer

  Cervical erosion refers to ulceration of the surface epithelium of the cervix resulting from trauma (as in childbirth) or infection. Cervical lacerations are likely to occur during childbirth. [medical-dictionary.thefreedictionary.com]

• Prolapse

  Definition Cervical dilatation in the absence of any abdominal pain Causes Cervical dilatation during termination of pregnancy Cone biopsy of the cervix (for suspected cervical cancer/neoplasia) cervical amputation during Manchester repair for uterine prolapse [dundeemedstudentnotes.wordpress.com]

  It is also associated with decreased length of cervix- Short Cervix It results in prolapse (bulging out ) and ballooning of membranes around fetus (Amniotic Sac/Amniotic Membranes-these membranes make a sac around fetus and protect the pregnancy ) into [practo.com]

  Errors & Delays Fetal Monitoring Errors Forceps & Vacuum Extractors Periventricular Leukomalacia (PVL) Placental Abruption Premature Birth Prolonged & Arrested Labor Seizures Umbilical Cord Complications Nuchal Cord Short Umbilical Cord True Knot Cord Prolapse [abclawcenters.com]

  […] of the umbilical cord臍帯脱出 prolapse of the uterus子宮脱 prolonged deceleration遅延一過性徐脈 pyometra子宮留膿症（腫） pyosalpinx卵管留膿症（腫） r recipient受容者、レシピエント rectal examination直腸診 remission induction chemotherapy寛解導入化学療法 repeat cesarean section反復帝王切開 s semen analysis精液検査 [tokyo-med.ac.jp]

  Emergency cerclage with concomitant amniocentesis as a method of treatment of membranes prolapse. Ginekol Pol, 72 (2001), pp. 1112-1115 [21.] SM Althuisius, GA Dekker, P Hummel, DJ Bekedam, HP. Van Geijn. [elsevier.es]

• Irritability

  This irritates the uterus and brings on pre-term labor. In many cases, labor is detected when it is too far advanced to stop the process. Cervical incompetence accounts for about 15 to 20 percent of all pregnancy losses during the second trimester. [healthcentral.com]

  A woman would not be eligible for a cerclage if: There is increased irritation of the cervix The cervix has dilated 4cm Membranes have ruptured Possible complications of cervical cerclage include uterine rupture, maternal hemorrhage, bladder rupture, [americanpregnancy.org]

  There are women who can’t have a cerclage put in place, for the following reasons: Cervix has already dilated 4cm Membranes have already ruptured There is increased irritation of the cervix. There are risks in having a cervical cerclage. [bellybelly.com.au]

  Many things can affect the length of your cervix, including: Having an overdistended (stretched or enlarged) uterus Problems caused by bleeding during pregnancy or inflammation (irritation) of the uterus Infection Cervical insufficiency Last reviewed: [marchofdimes.org]

  The success rate for cervical cerclage is supposed to be 80-90%. 7 Eligibility for a Cerclage Women who are eligible for a cerclage may have is increased irritation of the cervix, or their cervix has dilated 4 cm. [babygaga.com]

Various reports from different parts of the world have emphasized the markedly increased rates of cervical incompetence than previously anticipated [5] [7]. Thus, this condition is hypothesized to be a rather important cause of premature delivery, but of miscarriage and fetal loss as well, which is why the diagnosis should be made as early is possible. A history of repeated pregnancy loss or preterm births is one of the first and most important elements that could be identified during history taking [2]. Secondly, the presence of any of the mentioned risk factors is necessary during workup, suggesting that a thoroughly obtained patient history is a vital step in order to raise clinical suspicion toward cervical incompetence, especially because an asymptomatic course is seen in almost all women. On the other hand, transvaginal ultrasonography has shown to be of pivotal benefit in predicting the ability of the cervix to maintain normal pregnancy [2] [4]. Studies indicate that preterm birth or fetal expulsion is much higher if cervical shortening ≤15 mm and its dilation is observed, while protrusion of fetal membranes into the cervical canal might also be suggestive of cervical incompetence [2] [4]. In addition, fetal fibronectin (fFN), and interleukin-6 in amniotic fluid are mentioned by certain authors as potentially useful markers in predicting preterm delivery [2]. However, the information obtained during history taking remain crucial for the diagnosis of cervical incompetence, meaning that physicians must maintain a high index of suspicion in women with previous preterm deliveries and miscarriages.

This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history. [ncbi.nlm.nih.gov]

[…] can be controversial, with conflicting results, particularly regarding the efficacy of a cerclage placement as treatment. [radiopaedia.org]

Cervical incompetence is the frequent cause of abortion in the second trimester and premature delivery, with adverse fetal prognosis. Usually, three causative factors are considered: traumatic, constitutional, dysfunctional. [ncbi.nlm.nih.gov]

Sonographic determination of the residual closed length of the cervix may be measured if there is: known complicating pre-term premature rupture of membranes known hourglass type membranes active vaginal bleeding Treatment and prognosis Management options [radiopaedia.org]

In this innovative one-page format, you can review topics such as etiology/pathophysiology, differential diagnosis, presentation, diagnosis/evaluation, treatment options, and prognosis/complications for 126 topics. [books.google.com]

Prognosis While cervical insufficiency poses little serious threat to the mother, it can pose serious risks and even death for babies depending on what stage of pregnancy they are in when the situation develops. [babymed.com]

In most instances cervical incompetence is the result of previous obstetric or gynecologic trauma; a congenital etiology is unusual. [ncbi.nlm.nih.gov]

In this innovative one-page format, you can review topics such as etiology/pathophysiology, differential diagnosis, presentation, diagnosis/evaluation, treatment options, and prognosis/complications for 126 topics. [books.google.com]

Other proposed etiologies have included congenital müllerian anomalies, deficiencies in cervical collagen and elastin, and in utero exposure to diethylstilbestrol. [dx.doi.org]

This retrospective study was aimed to review epidemiology, management and outcome of cervical incompetence in Ramathibodi Hospital, Mahidol University, Thailand, from 1982 to 1997. [ncbi.nlm.nih.gov]

REFERENCES Harlap and Davies, "Late Sequelae of Induced Abortion: Complications and Outcome of Pregnancy and Labor", American Journal of Epidemiology (1975), vol.102,no.3. [life.org.nz]

Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva Israel [doi.org]

To date, no definitive epidemiologic studies have proved that cervical insufficiency is more frequent in women exposed to diethylstilbestrol than in comparable control subjects. There are no randomized trials of cerclage in these patients. [aafp.org]

Controversy exists in the medical literature pertaining to issues of pathophysiology, screening, diagnosis, and management of cervical insufficiency. [ncbi.nlm.nih.gov]

A limited understanding of the pathophysiology of premature labor, difficulty of making the diagnosis, the low predictive value of the known risk factors, and the lack of effective. .. Sabrina D. Craigo, M.D. [nejm.org]

In this innovative one-page format, you can review topics such as etiology/pathophysiology, differential diagnosis, presentation, diagnosis/evaluation, treatment options, and prognosis/complications for 126 topics. [books.google.com]

The pathophysiology of cervical insufficiency is still poorly understood. [dx.doi.org]

Objectives To evaluate the efficacy of cervical pessary for the prevention of preterm birth in women with risk factors for cervical incompetence. [doi.org]

Surgical treatment of cervical incompetence to prevent early abortion or premature labour has been accepted since Shirodkar introduced his operation in 1955. [ncbi.nlm.nih.gov]

Prevention of preterm birth is therefore a major goal of obstetric care of multiple pregnancy. However, strategies to prevent preterm birth in these patients have been largely unsuccessful. [dx.doi.org]

1. Lotgering FK. Clinical aspects of cervical insufficiency. BMC Pregnancy Childbirth. 2007;7(Suppl 1):S17.
2. Chandiramani M, Shennan AH. Cervical insufficiency: prediction, diagnosis and prevention. The Obstetrician & Gynaecologist, 2008;10:99–106.
3. Anum EA, Brown HL, Strauss JF. Health disparities in risk for cervical insufficiency. Hum Reprod. 2010;25(11):2894-2900.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Bánhidy F, Acs N, Puhó EH, Czeizel AE. Association of very high Hungarian rate of preterm births with cervical incompetence in pregnant women. Cent Eur J Public Health. 2010;18(1):8-15.
6. McElrath TF. Unappreciated but not unimportant: health disparities in the risk for cervical insufficiency. Hum Reprod. 2010;25(11):2891-2893.
7. Feigenbaum SL, Crites Y, Hararah MK, Yamamoto MP, Yang J, Lo JC. Prevalence of cervical insufficiency in polycystic ovarian syndrome. Hum Reprod. 2012;27(9):2837-2842.